Proposal for a New Classification of Cesarean Sections for Developing Countries: A Multicenter Study in Five Maternity Hospitals in Dakar

Objectives: The general objective of this study was to contribute to the study of the classification of cesarean sections. The specific objectives were to propose a new classification of cesarean sections based on the obstetrical complications specified by the WHO and to see the applicability of this classification, especially in Africa.

Methods: This is a prospective, descriptive and analytical study, consisting of a review of the records of patients received at the level of the target maternities and who had a caesarean section during the period from January 1, 2019 to December 31, 2019 (12 months). Our study was conducted at five level 2 and 3 maternity hospitals. All patients who had a cesarean section during the study period were included in the study, as well as those with a uterine rupture discovered during cesarean section in one of the study maternity units in the Dakar region.

We proposed a classification of cesarean section into four groups. In patients with interrelated causes for cesarean section, the most urgent primary indication was used to classify patients into one of the groups.

Results: Group I represented parturients with a direct obstetric complication; group II was for patients with an indirect obstetric complication; patients with a fetal complication were grouped in group III. Group IV was for prophylactic cesarean sections. With this distribution, we obtained the following proportions. Group I comprised the majority of indications with 40.9%, group II was the least represented with 3.5%; groups III and IV represented 32% and 24% respectively. Group I of our classification encompasses almost all major obstetrical emergencies and thus allows us to understand that our high rates of cesarean section in our facilities are justified.

Conclusion: Direct and indirect obstetrical complications are the main causes of maternal death. Taking these obstetrical complications into account in the cesarean. section classification systems would contribute to a better control of maternal deaths.